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Home My Public Portal About5439 BALDWIN AVE_Sewer__ (2) E808 D Cseoe APPLICATION FO PERMIT a ss COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY D gM+sSION nILDING nDREss 1„9 kIN AP CASSATT D GRIFFIN SuLANZIE pt of Buildiaq LOCALITY mialm NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIP ION LOT NO OWNER D WA- /V BLOCKTRACT MAIL ADDRESS (Z'Nd OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USEOF DI DISTRICT NO GROUP MAP PROC SSED BY BUILDINGS ��'� BK P6 CONTRACTOR i ADDRESS 3 CONNECTION DATA �/ AION DEPTH CITY TEL NO ® !fir/ [�p'D a 1B STATE MANHOLE EF RENC PER / REGISTRATION NO COUNTY / (J L NO I DESCRIPTION OF WORK FEE �� HOUSE SEWER CONNECTING TO i PUBLIC SEWER @ $3 00 TYPE OF CONNECTION' LENGTH FROrM SEPTIC TANK SEEPAGE PIT OR Y CURB P L. M L TO P L l7 ii PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM @ $100 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER @ $1 00 SEWER OR DISPOR AL ANDON SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO 6A INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE C-0 REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON J TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE *INCTOR S S GNAT RE TO THE PUBLIC SEWER % '` 1SIGNED THIS DAY OF 9_ NEW HOUSE SEWER 1( /9 OWNER OR CONNECT ADDITIONAL / { ( OWNERS AGENT Q BUILDING OR WORK d �/h n iv p l SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD e/ ANDEREBY STATEACKNOWLEDGE HAT I HAVE R THAT THE CORRECT AND AGREEEAD THIS COMPO DLY CESSPOOL ❑ DRYWELL ❑ [ V 1lI/v 4,P WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR r Y PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM r I 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND t� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER J CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI L PROPERTY � BACKFILL SEPTIC TANKS ❑ SE PIT(S) Cl CESSPOOLS ❑ SIGNATURE OF PERMITTE 11,E ®p VALIDATION----) ROBERT A WOOD ` OK (M a GASB SUPERVISING MECHANICAL ENGINEER �,� 2 n 3 7 ,tU.'d ?7 1 2 D 2 5 0 0 78A647D APPLICATION FOR ERMIT CESOB a ea COUNTY OF LOS ANGELES SEWER—SEWAGE ISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION FNEARESI 7 OHN A LAMBIE CouatF En eer C ITDGBIFFIN Supt of Build3ag r+ FOR APPLICANT TO FILL C B T vW LEGAL s– DESCRIPTION LOTNO OWNEROR BLOCK TRA MAIL ADDRESS SIZE OF G}� �D LOT CITY TEL NO USOF BUE DINGS I -2- DISTRICT NO GROUP BK PG MAP PROCESSED BY I CONTRACTOR f1 ADDRESS l ��,.r/ V CONNECTION ATA CITY TEL NO �1 (��y y TION DEPTH STATE MANHOLE REFERENCEv ER FF�� REGISTRATION NO 3 a B COUNTY �G,, No I DESCRIPTION WORK FEE HOUSE SEWER CONNECTING TO _ PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD ES 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ S200 HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER @ $1 00 SEWER OR DISPOSAL ANDONA HOUSE @ $f 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT $ 200 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAI S DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR �� CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN A PROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SEE PITS) ❑ POOLS OF PERMITTE ®T VALIDATION ROBERT A WOOD CK M 0 CAStl SUPERVISING MECHANICAL ENGINEER `�CO2856 -0 JT1271 0 D JGO i�